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Misaligned eyes common in newborns, time to see doctor in older kids

We focus so much on babies’ eyes when they’re born. Right after parents share the name, weight and length details on their new bundle of joy, the next questions from friends are usually about the infant’s eyes. What color are they? Are they open and alert? Closed tight and sleepy? Do they look like Mom’s or Dad’s?

It’s no wonder that new parents often become concerned when they notice their baby’s eyes look a little funny, maybe even crossed. Generally, parents can relax about this issue if their little one is less than 4 months of age. Sometimes newborns’ eyes just look misaligned while they’re trying to focus.

The most important thing parents need to watch for with a baby’s vision before the age of 4 months is how they track or follow objects as these items move through the child’s field of vision. If it seems as though a baby can’t make some eye contact or is unable to follow an item, parents do need to discuss the issue with their pediatrician.

“A baby that has a true problem will not outgrow it,” says Dr. A.B. Naylor, an optometrist at the Eye Center at Arkansas Children’s Hospital. “That child really needs a complete exam by an eye care professional.”

As children grow older, parents should be more concerned if they notice misalignment in their child’s eyes.

“Some people call an eyelid that droops ‘lazy eye,’ while others may call an eye that turns up or down by the same name,” Naylor says. “Sometimes, we hear an eye that just doesn’t see well referred to the same way.”

The type of misalignment usually noticed in children’s eyes has another name. “Strabismus” – when an eye turns turns inward, upward, downward or outward – is one of the more common vision conditions treated at Arkansas Children’s Hospital, according to Naylor. It affects about 5 percent of the population and is caused by poor communication between the brain and eye muscles.

Strabismus can sometimes be treated with glasses, though surgery is often required if the condition is congenital. The procedure can be done on an outpatient basis, and involves moving or shortening the eye muscles so the eye stays in the right position. Congenital strabismus usually shows up by the time a child is 3 years old, Naylor says.

“With strabismus that shows up later, everything is usually OK with the muscles, it’s just that both eyes don’t line up as they’re supposed to,” he adds. “One of them is working at a different point than the other.”

If you notice that a child’s eyes aren’t aligning correctly, Naylor suggests you bring it up to your pediatrician, who can make a referral to an optometrist or ophthalmologist for a more in-depth exam.

Other eye issues that need to be pointed out to a child’s pediatrician include whitish or gray coloring in the pupils; drooping eyelids; bulging eyes; eyes that flutter quickly in one direction or another; redness that doesn’t resolve and isn’t related to pink eye; eyes that are constantly watery; sensitivity to light; and any change in a child’s eyes from how they normally look.

New parents will spend many hours gazing into their babies’ eyes as they take in the world around them. A little misalignment in those early days won’t take long to resolve for the majority of infants. But keeping our own eyes open to detect other issues will help kids see much better in the long run.

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Dr. Sam Smith is surgeon in chief at Arkansas Children’s Hospital and a professor of Surgery at the University of Arkansas for Medical Sciences. He writes a column each week covering a variety of kids’ medical concerns. If you have a topic you’d like him to consider addressing, email achconnect@archildrens.org.